Earned Income Tax Credit (EITC) Client Questionnaire

Full Name

First NameLast Name

Email Address

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Current Address

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

What is your filing status for this tax year?

How many dependents (children or relatives) will you claim this year?

Please list the names and ages of all dependents you will claim.

Did you (and your spouse, if married) live in the United States for more than half of the year?

Which of the following types of income did you or your spouse receive this year? (Select all that apply)

Are you or your spouse a full-time student or permanently and totally disabled?

Has anyone else claimed you or your dependents on their tax return this year?

Please provide any additional information or circumstances that may affect your eligibility for EITC.